Provider Demographics
NPI:1366695348
Name:SMITH, NICOLE R (APRN-BC)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:R
Last Name:SMITH
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W 110TH ST STE 700
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2332
Mailing Address - Country:US
Mailing Address - Phone:816-377-1551
Mailing Address - Fax:
Practice Address - Street 1:7300 W 110TH ST STE 700
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2332
Practice Address - Country:US
Practice Address - Phone:816-377-1551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-04
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS46302363LF0000X
MO2004004105363LP2300X
MO2021038560363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOMA1521022Medicare PIN
MOX93000037Medicare PIN
MOK67000030Medicare PIN